Post-cardiac injury syndrome (PCIS) is an inflammatory process involving the pericardium secondar... more Post-cardiac injury syndrome (PCIS) is an inflammatory process involving the pericardium secondary to cardiac injury. It can develop after cardiac trauma, cardiac surgery, myocardial infarction, and, rarely, after certain intravascular procedures. We report a rare case of an iatrogenic cardiac rupture followed by PCIS with delayed inflammatory pericardial effusion after pacemaker implantation. A comprehensive literature review on this topic is provided.
International Journal of Health Science, Jan 26, 2024
In this work, we present a literature review about palliative care, from a perspective of the pri... more In this work, we present a literature review about palliative care, from a perspective of the principles and values that underlie it. Palliative Care (PC) is an approach that promotes the quality of life of patients and family members, who face illnesses that threaten the continuity of life, through prevention and relief of suffering. METHODOLOGY: This is a literature review, of a narrative type, which aims to describe palliative care and its principles and values, from a theoretical point of view, through materials that have already been published on the topic in question, through analysis and interpretation of literature. The inclusion criteria were: articles in Portuguese and English; published between 2019 and 2024 and which addressed the themes proposed for this research, reviewtype studies made available in full. The need to expand services dedicated to palliative care is discussed. RESULT AND DISCUSSION: Palliative care requires the early identification, assessment and treatment of pain and other problems of a physical, psychosocial and spiritual nature. This work seeks to identify and address the principles and values of palliative care, contributing to the study, deepening and dissemination of this topic in academia, professionals and society in general. CONCLUSION: The propagation of the subject contributes to the debate within the scope of public health policies and assists in the process of training and training professionals to act with competence and respect for human dignity until the last moments of sick people's lives.
Cateterização Swan-Ganz; Hemoptises Hemoptises massivas como complicação pouco habitual do catete... more Cateterização Swan-Ganz; Hemoptises Hemoptises massivas como complicação pouco habitual do cateterismo direito: um tratamento bem-sucedido com stent percutâneo Resumo Os autores descrevem um caso de sucesso do tratamento da rotura da artéria pulmonar com a implantação de um stent endovascular.
The purpose of this study was to clarify the impact of obesity on cardiac prognosis in CHF patien... more The purpose of this study was to clarify the impact of obesity on cardiac prognosis in CHF patients with or without Met. Methods and results: Consecutive 374 patients (mean 68±12 years) were enrolled. Patients were divided into 3 groups (T1-3) according to body mass index (BMI) tertile. After the discharge, the patients were followed 2 years. Endpoints were (1) cardiac death and (2) readmission by worsening heart failure. There were 126 cardiac events (34%) including 32 cardiac deaths and 94 readmission during the follow-up period. Fifty-two patients (14%) with MetS showed lower age and higher BMI compared with those without MetS. Moreover, patients with MetS showed higher serum triglyceride level, higher serum low density lipoprotein cholesterol level, and lower serum high-density lipoprotein cholesterol level compared with those without MetS. There were no significant differences in etiologies of CHF and medication. In all patients and non-MetS patients, serum BNP level was decreased with increasing of BMI (ANOVA p<0.01 each). However, in MetS patients, this tendency was not recognized. Kaplan-Meier analysis revealed that significantly lower cardiac event rates were observed in T3 in all patients and non-MetS patients (log-rank test p<0.001, each). However, in MetS patients, there was no association between BMI and cardiac events. In Cox hazard analysis showed that in all patients and non-MetS patients, T3 (hazard ratio 0.5, 95% CI 0.3-0.8 for all CHF and hazard ratio 0.4, 95% CI 0.3-0.8 for non-MetS) was independently associated with cardiac events after adjustment of age, gender, NYHA functional class and serum BNP level. However, in MetS patients, BMI was not independently associated with cardiac events. Conclusion: Advantage of obesity was not recognized in CHF patients with MetS. Our results provide an important insight into obesity paradox in CHF patients.
Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all... more Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all ischemic strokes. 24-hour Holter monitoring in stroke and transient ischemic attack (TIA) patients is used as a routine investigation to search for occult paroxysmal atrial fibrillation (PAF), which may have crucial prognostic impact. Excessive supraventricular ectopic activity (ESVEA) is also a stroke risk factor, probably related to the risk of developing AF. Purpose To observe the incidence of AF at a long-term follow-up and to evaluate the clinical, electrocardiographic and echocardiographic predictors of new onset AF in stroke patients. Methods Patients in sinus rhythm who performed Holter between October 2009 and October 2011 in the setting of post stroke or TIA were included; patients with previous AF were excluded. These patients were followed for 8 to 10 years. Clinical, electrocardiographic and echocardiographic data were collected. ESVEA was defined by ≥500 premature atrial contractions per 24 hours or any sustained supraventricular tachycardia episode. Results 104 patients were included, 54% were male, with a mean age of 63.8±14.7 years at the time of the event. In relation to cardiovascular risk factors, 59% had hypertension, 47% dyslipidemia, 14% diabetes, 44% were smokers or previous smokers; 67% of patients were high consumers of alcohol. 79.8% had a stroke and 21.2% a TIA. 24-hour Holter monitoring revealed ESVEA in 13.5% of patients and PAF in 1.9%. All patients with PAF had a previous stroke and were older than 55. At a follow-up of 8–10 years, new onset AF was detected in 11.5%; these patients had similar mortality comparing to those in sustained sinus rhythm (21.2% vs 16.7%, p=0.724). Alcohol intake, an established risk factor for development of AF, was associated with a non-significant increase of AF (17.3% vs 11.5%) while the presence of cardiovascular risk factors was not associated with AF development. We found a statistically significant difference between patients with and without ESVEA concerning to new onset of AF (35.7% vs 8.0%, p=0.010). ESVEA seems to be related with a higher mortality at a long follow-up, although this difference wasn&amp;amp;amp;#39;t statistically significant (35.7% vs 18.2%, p=0.132). Concerning to echocardiographic parameters, patients whit left atrium enlargement showed a higher incidence of AF at follow-up (14.7% vs 7.9%), and the presence of mitral regurgitation were not related with new onset of AF. Patients&amp;amp;amp;#39; age was also not related with new onset of AF during follow-up. Conclusion Atrial fibrillation is considered the main cause of stroke. Our study showed that ESVEA is a strong predictor of new onset AF and highlights that Holter monitoring could be an important tool not only to diagnose AF but also to identify patients in risk of develop AF. Diagnostic of new AF during long-term follow up didn&amp;amp;amp;#39;t correlate with higher mortality. Funding Acknowledgement Type of funding source: None
Proença et al. Preditores de Fibrilação Atrial em Holter Vinculação acadêmica Não há vinculação d... more Proença et al. Preditores de Fibrilação Atrial em Holter Vinculação acadêmica Não há vinculação deste estudo a programas de pósgraduação. Aprovação ética e consentimento informado Este artigo não contém estudos com humanos ou animais realizados por nenhum dos autores.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease affecting the hear... more Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease affecting the heart muscle. It is clinically characterized by life-threatening ventricular arrhythmias. Although it primarily affects the right ventricle, the left
OBJECTIVE Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV... more OBJECTIVE Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV), linked to an increased risk of sudden death in various other diseases. In this context, it could play a role in SUDEP. Generalized convulsive seizures (GCS) are one of the most consensual risk factors for SUDEP. Our objective was to assess the influence of GCS in HRV parameters in patients with drug-resistant epilepsy. METHODS We prospectively evaluated 121 patients with refractory epilepsy admitted to our Epilepsy Monitoring Unit. All patients underwent a 48-hour Holter recording. Only patients with GCS were included (n = 23), and we selected the first as the index seizure. We evaluated HRV (AVNN, SDNN, RMSSD, pNN50, LF, HF, and LF/HF) in 5-min epochs (diurnal and nocturnal baselines; preictal - 5 min before the seizure; ictal; postictal - 5 min after the seizure; and late postictal - >5 h after the seizure). These data were also compared with normative values from a healthy population (controlling for age and gender). RESULTS We included 23 patients, with a median age of 36 (min-max, 16-55) years and 65% were female. Thirty percent had cardiovascular risk factors, but no previously known cardiac disease. HRV parameters AVNN, RMSSD, pNN50, and HF were significantly lower in the diurnal than in the nocturnal baseline, whereas the opposite occurred with LF/HF and HR. Diurnal baseline parameters were inferior to the normative population values (which includes only diurnal values). We found significant differences in HRV parameters between the analyzed periods, especially during the postictal period. All parameters but LF/HF suffered a reduction in that period. LF/HF increased in that period but did not reach statistical significance. Visually, there was a tendency for a global reduction in our patients' HRV parameters, namely AVNN, RMSSD, and pNN50, in each period, comparing with those from a normative healthy population. No significant differences were found in HRV between diurnal and nocturnal seizures, between temporal lobe and extra-temporal-lobe seizures, between seizures with and without postictal generalized EEG suppression, or between seizures of patients with and without cardiovascular risk factors. SIGNIFICANCE/CONCLUSION Our work reinforces the evidence of autonomic cardiac dysfunction in patients with refractory epilepsy, at baseline and mainly in the postictal phase of a GCS. Those changes may have a role in some SUDEP cases. By identifying patients with worse autonomic cardiac function, HRV could fill the gap of a lacking SUDEP risk biomarker.
Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all... more Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all ischemic strokes. 24-hour Holter monitoring in stroke and transient ischemic attack (TIA) patients is used as a routine investigation to search for occult paroxysmal atrial fibrillation (PAF), which may have crucial prognostic impact. Excessive supraventricular ectopic activity (ESVEA) is also a stroke risk factor, probably related to the risk of developing AF. Purpose To observe the incidence of AF at a long-term follow-up and to evaluate the clinical, electrocardiographic and echocardiographic predictors of new onset AF in stroke patients. Methods Patients in sinus rhythm who performed Holter between October 2009 and October 2011 in the setting of post stroke or TIA were included; patients with previous AF were excluded. These patients were followed for 8 to 10 years. Clinical, electrocardiographic and echocardiographic data were collected. ESVEA was defined by ≥500 premature atrial c...
Background Seizures commonly affect the heart rate and its variability. The increased interest in... more Background Seizures commonly affect the heart rate and its variability. The increased interest in this area of research is related to the possible connection with sudden unexpected death in epilepsy (SUDEP). Generalized tonic-clonic seizures (GTCS) are reported as the most consistent risk factor for SUDEP. However, the general risk of seizures (and their type) on cardiac function still remains uncertain. Purpose To evaluate the influence of seizure type (GTCS vs non-GTCS) on ictal and early post-ictal Heart Rate Variability (HRV) in patients with refractory epilepsy. Methods From January 2015 to July 2018, we prospectively evaluated 121 patients admitted to our institution's Epilepsy Monitoring Unit with focal resistant epilepsy. All patients underwent a 48-hour Holter recording. We included only patients who had both GTCS and non-GTCS during the recording and selected the first seizure of each type to analyze. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing...
Background Heart Rate Variability (HRV) is an increasing area of interest in patients with epilep... more Background Heart Rate Variability (HRV) is an increasing area of interest in patients with epilepsy. The effects of epilepsy on the autonomic control of the heart are not completely understood and that autonomic dysfunction has been implicated in some cases of Sudden Unexpected Death in Epilepsy (SUDEP). Objective To study the influence of generalized tonic-clonic seizures (GTCS) on HRV of patients with focal refractory epilepsy. Method We prospectively evaluated (January 2015 to July 2018) 121 patients admitted to our institution's Epilepsy Monitoring Unit. All patients performed a 48-hour Holter recording. Patients who had GTCS during the recording were included and we selected the first GTCS as the index seizure. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs during inter-ictal and post-ictal periods: baseline, pre-ictal (5 min before the GTCS seizure), post-ictal (5 min after the seizure), and late post-ictal (>5 hours after the seiz...
European Journal of Heart Failure Supplements, 2004
... S. Amorim I , J. Freitas 2, M. Campelo 1 , B. Moura 1 , J. Silva-Cardoso I , J. Pinheiro-Torr... more ... S. Amorim I , J. Freitas 2, M. Campelo 1 , B. Moura 1 , J. Silva-Cardoso I , J. Pinheiro-Torres 3, MJ Amorim 3, E Bastos 3 , E Rocha-Gon ... S. Martins 1, RM Soares 1 , F. Miranda% MU Ferreira 1, A. Fiarresga 1 , J. Feliciano 1 , N. Pelicano 1 , CB Palma 2, B. Oliveira 2, J. Qnininha t ...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1992
The present work is an attempt to provide a general overview on the current methods and applicati... more The present work is an attempt to provide a general overview on the current methods and applications of heart rate variability (HRV), starting from the underlying mechanisms of cardiac rhythmic automaticity and the influence on heart rate of biological modulators, namely autonomous nervous system. Different evaluation methods for HRV are compared in what concerns the duration of the records under analysis and the mathematical approach (spectral/non-spectral). Finally, clinical applications of HRV are mentioned, some of them the Department is particularly interested in, namely coronary heart disease, heart failure and diabetic neuropathy. The authors conclude, minding some aspects susceptible of discussion in the future of this technique.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1993
1--To determine the accuracy of the echocardiographic selection and characterization of the pulmo... more 1--To determine the accuracy of the echocardiographic selection and characterization of the pulmonary stenosis (PS) for balloon valvuloplasty; 2--To analyze the differences between children and adults in obtaining the echocardiographic parameters used for pulmonary stenosis characterization. We studied 53 consecutive patients with PS and a peak Doppler gradient > or = 40 mmHg, submitted to cardiac catheterization to perform balloon valvuloplasty if the right ventricle to pulmonary artery peak-to-peak systolic pressure gradient was > or = 40 mmHg. The patients were divided into 3 groups on the basis of age: < or = 5 years (group 1; n = 18), 6-16 years (group 2; n = 17) and > 16 years (group 3; n = 18). A complete echocardiographic study was performed including identification of valvular morphology (commissural fusion, dysplasia or mixed), determination of right ventricle to pulmonary artery peak Doppler gradient and the transducer position that yielded the highest transva...
Post-cardiac injury syndrome (PCIS) is an inflammatory process involving the pericardium secondar... more Post-cardiac injury syndrome (PCIS) is an inflammatory process involving the pericardium secondary to cardiac injury. It can develop after cardiac trauma, cardiac surgery, myocardial infarction, and, rarely, after certain intravascular procedures. We report a rare case of an iatrogenic cardiac rupture followed by PCIS with delayed inflammatory pericardial effusion after pacemaker implantation. A comprehensive literature review on this topic is provided.
International Journal of Health Science, Jan 26, 2024
In this work, we present a literature review about palliative care, from a perspective of the pri... more In this work, we present a literature review about palliative care, from a perspective of the principles and values that underlie it. Palliative Care (PC) is an approach that promotes the quality of life of patients and family members, who face illnesses that threaten the continuity of life, through prevention and relief of suffering. METHODOLOGY: This is a literature review, of a narrative type, which aims to describe palliative care and its principles and values, from a theoretical point of view, through materials that have already been published on the topic in question, through analysis and interpretation of literature. The inclusion criteria were: articles in Portuguese and English; published between 2019 and 2024 and which addressed the themes proposed for this research, reviewtype studies made available in full. The need to expand services dedicated to palliative care is discussed. RESULT AND DISCUSSION: Palliative care requires the early identification, assessment and treatment of pain and other problems of a physical, psychosocial and spiritual nature. This work seeks to identify and address the principles and values of palliative care, contributing to the study, deepening and dissemination of this topic in academia, professionals and society in general. CONCLUSION: The propagation of the subject contributes to the debate within the scope of public health policies and assists in the process of training and training professionals to act with competence and respect for human dignity until the last moments of sick people's lives.
Cateterização Swan-Ganz; Hemoptises Hemoptises massivas como complicação pouco habitual do catete... more Cateterização Swan-Ganz; Hemoptises Hemoptises massivas como complicação pouco habitual do cateterismo direito: um tratamento bem-sucedido com stent percutâneo Resumo Os autores descrevem um caso de sucesso do tratamento da rotura da artéria pulmonar com a implantação de um stent endovascular.
The purpose of this study was to clarify the impact of obesity on cardiac prognosis in CHF patien... more The purpose of this study was to clarify the impact of obesity on cardiac prognosis in CHF patients with or without Met. Methods and results: Consecutive 374 patients (mean 68±12 years) were enrolled. Patients were divided into 3 groups (T1-3) according to body mass index (BMI) tertile. After the discharge, the patients were followed 2 years. Endpoints were (1) cardiac death and (2) readmission by worsening heart failure. There were 126 cardiac events (34%) including 32 cardiac deaths and 94 readmission during the follow-up period. Fifty-two patients (14%) with MetS showed lower age and higher BMI compared with those without MetS. Moreover, patients with MetS showed higher serum triglyceride level, higher serum low density lipoprotein cholesterol level, and lower serum high-density lipoprotein cholesterol level compared with those without MetS. There were no significant differences in etiologies of CHF and medication. In all patients and non-MetS patients, serum BNP level was decreased with increasing of BMI (ANOVA p<0.01 each). However, in MetS patients, this tendency was not recognized. Kaplan-Meier analysis revealed that significantly lower cardiac event rates were observed in T3 in all patients and non-MetS patients (log-rank test p<0.001, each). However, in MetS patients, there was no association between BMI and cardiac events. In Cox hazard analysis showed that in all patients and non-MetS patients, T3 (hazard ratio 0.5, 95% CI 0.3-0.8 for all CHF and hazard ratio 0.4, 95% CI 0.3-0.8 for non-MetS) was independently associated with cardiac events after adjustment of age, gender, NYHA functional class and serum BNP level. However, in MetS patients, BMI was not independently associated with cardiac events. Conclusion: Advantage of obesity was not recognized in CHF patients with MetS. Our results provide an important insight into obesity paradox in CHF patients.
Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all... more Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all ischemic strokes. 24-hour Holter monitoring in stroke and transient ischemic attack (TIA) patients is used as a routine investigation to search for occult paroxysmal atrial fibrillation (PAF), which may have crucial prognostic impact. Excessive supraventricular ectopic activity (ESVEA) is also a stroke risk factor, probably related to the risk of developing AF. Purpose To observe the incidence of AF at a long-term follow-up and to evaluate the clinical, electrocardiographic and echocardiographic predictors of new onset AF in stroke patients. Methods Patients in sinus rhythm who performed Holter between October 2009 and October 2011 in the setting of post stroke or TIA were included; patients with previous AF were excluded. These patients were followed for 8 to 10 years. Clinical, electrocardiographic and echocardiographic data were collected. ESVEA was defined by ≥500 premature atrial contractions per 24 hours or any sustained supraventricular tachycardia episode. Results 104 patients were included, 54% were male, with a mean age of 63.8±14.7 years at the time of the event. In relation to cardiovascular risk factors, 59% had hypertension, 47% dyslipidemia, 14% diabetes, 44% were smokers or previous smokers; 67% of patients were high consumers of alcohol. 79.8% had a stroke and 21.2% a TIA. 24-hour Holter monitoring revealed ESVEA in 13.5% of patients and PAF in 1.9%. All patients with PAF had a previous stroke and were older than 55. At a follow-up of 8–10 years, new onset AF was detected in 11.5%; these patients had similar mortality comparing to those in sustained sinus rhythm (21.2% vs 16.7%, p=0.724). Alcohol intake, an established risk factor for development of AF, was associated with a non-significant increase of AF (17.3% vs 11.5%) while the presence of cardiovascular risk factors was not associated with AF development. We found a statistically significant difference between patients with and without ESVEA concerning to new onset of AF (35.7% vs 8.0%, p=0.010). ESVEA seems to be related with a higher mortality at a long follow-up, although this difference wasn&amp;amp;amp;#39;t statistically significant (35.7% vs 18.2%, p=0.132). Concerning to echocardiographic parameters, patients whit left atrium enlargement showed a higher incidence of AF at follow-up (14.7% vs 7.9%), and the presence of mitral regurgitation were not related with new onset of AF. Patients&amp;amp;amp;#39; age was also not related with new onset of AF during follow-up. Conclusion Atrial fibrillation is considered the main cause of stroke. Our study showed that ESVEA is a strong predictor of new onset AF and highlights that Holter monitoring could be an important tool not only to diagnose AF but also to identify patients in risk of develop AF. Diagnostic of new AF during long-term follow up didn&amp;amp;amp;#39;t correlate with higher mortality. Funding Acknowledgement Type of funding source: None
Proença et al. Preditores de Fibrilação Atrial em Holter Vinculação acadêmica Não há vinculação d... more Proença et al. Preditores de Fibrilação Atrial em Holter Vinculação acadêmica Não há vinculação deste estudo a programas de pósgraduação. Aprovação ética e consentimento informado Este artigo não contém estudos com humanos ou animais realizados por nenhum dos autores.
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease affecting the hear... more Arrhythmogenic right ventricular cardiomyopathy (ARVC) is an inherited disease affecting the heart muscle. It is clinically characterized by life-threatening ventricular arrhythmias. Although it primarily affects the right ventricle, the left
OBJECTIVE Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV... more OBJECTIVE Patients with epilepsy, mainly drug-resistant, have reduced heart rate variability (HRV), linked to an increased risk of sudden death in various other diseases. In this context, it could play a role in SUDEP. Generalized convulsive seizures (GCS) are one of the most consensual risk factors for SUDEP. Our objective was to assess the influence of GCS in HRV parameters in patients with drug-resistant epilepsy. METHODS We prospectively evaluated 121 patients with refractory epilepsy admitted to our Epilepsy Monitoring Unit. All patients underwent a 48-hour Holter recording. Only patients with GCS were included (n = 23), and we selected the first as the index seizure. We evaluated HRV (AVNN, SDNN, RMSSD, pNN50, LF, HF, and LF/HF) in 5-min epochs (diurnal and nocturnal baselines; preictal - 5 min before the seizure; ictal; postictal - 5 min after the seizure; and late postictal - >5 h after the seizure). These data were also compared with normative values from a healthy population (controlling for age and gender). RESULTS We included 23 patients, with a median age of 36 (min-max, 16-55) years and 65% were female. Thirty percent had cardiovascular risk factors, but no previously known cardiac disease. HRV parameters AVNN, RMSSD, pNN50, and HF were significantly lower in the diurnal than in the nocturnal baseline, whereas the opposite occurred with LF/HF and HR. Diurnal baseline parameters were inferior to the normative population values (which includes only diurnal values). We found significant differences in HRV parameters between the analyzed periods, especially during the postictal period. All parameters but LF/HF suffered a reduction in that period. LF/HF increased in that period but did not reach statistical significance. Visually, there was a tendency for a global reduction in our patients' HRV parameters, namely AVNN, RMSSD, and pNN50, in each period, comparing with those from a normative healthy population. No significant differences were found in HRV between diurnal and nocturnal seizures, between temporal lobe and extra-temporal-lobe seizures, between seizures with and without postictal generalized EEG suppression, or between seizures of patients with and without cardiovascular risk factors. SIGNIFICANCE/CONCLUSION Our work reinforces the evidence of autonomic cardiac dysfunction in patients with refractory epilepsy, at baseline and mainly in the postictal phase of a GCS. Those changes may have a role in some SUDEP cases. By identifying patients with worse autonomic cardiac function, HRV could fill the gap of a lacking SUDEP risk biomarker.
Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all... more Background Cardioembolism induced by atrial fibrillation (AF) is responsible for up to 33% of all ischemic strokes. 24-hour Holter monitoring in stroke and transient ischemic attack (TIA) patients is used as a routine investigation to search for occult paroxysmal atrial fibrillation (PAF), which may have crucial prognostic impact. Excessive supraventricular ectopic activity (ESVEA) is also a stroke risk factor, probably related to the risk of developing AF. Purpose To observe the incidence of AF at a long-term follow-up and to evaluate the clinical, electrocardiographic and echocardiographic predictors of new onset AF in stroke patients. Methods Patients in sinus rhythm who performed Holter between October 2009 and October 2011 in the setting of post stroke or TIA were included; patients with previous AF were excluded. These patients were followed for 8 to 10 years. Clinical, electrocardiographic and echocardiographic data were collected. ESVEA was defined by ≥500 premature atrial c...
Background Seizures commonly affect the heart rate and its variability. The increased interest in... more Background Seizures commonly affect the heart rate and its variability. The increased interest in this area of research is related to the possible connection with sudden unexpected death in epilepsy (SUDEP). Generalized tonic-clonic seizures (GTCS) are reported as the most consistent risk factor for SUDEP. However, the general risk of seizures (and their type) on cardiac function still remains uncertain. Purpose To evaluate the influence of seizure type (GTCS vs non-GTCS) on ictal and early post-ictal Heart Rate Variability (HRV) in patients with refractory epilepsy. Methods From January 2015 to July 2018, we prospectively evaluated 121 patients admitted to our institution's Epilepsy Monitoring Unit with focal resistant epilepsy. All patients underwent a 48-hour Holter recording. We included only patients who had both GTCS and non-GTCS during the recording and selected the first seizure of each type to analyze. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing...
Background Heart Rate Variability (HRV) is an increasing area of interest in patients with epilep... more Background Heart Rate Variability (HRV) is an increasing area of interest in patients with epilepsy. The effects of epilepsy on the autonomic control of the heart are not completely understood and that autonomic dysfunction has been implicated in some cases of Sudden Unexpected Death in Epilepsy (SUDEP). Objective To study the influence of generalized tonic-clonic seizures (GTCS) on HRV of patients with focal refractory epilepsy. Method We prospectively evaluated (January 2015 to July 2018) 121 patients admitted to our institution's Epilepsy Monitoring Unit. All patients performed a 48-hour Holter recording. Patients who had GTCS during the recording were included and we selected the first GTCS as the index seizure. HRV (AVNN, SDNN, RMSSD, pNN50, and LF/HF) was evaluated by analyzing 5-min-ECG epochs during inter-ictal and post-ictal periods: baseline, pre-ictal (5 min before the GTCS seizure), post-ictal (5 min after the seizure), and late post-ictal (>5 hours after the seiz...
European Journal of Heart Failure Supplements, 2004
... S. Amorim I , J. Freitas 2, M. Campelo 1 , B. Moura 1 , J. Silva-Cardoso I , J. Pinheiro-Torr... more ... S. Amorim I , J. Freitas 2, M. Campelo 1 , B. Moura 1 , J. Silva-Cardoso I , J. Pinheiro-Torres 3, MJ Amorim 3, E Bastos 3 , E Rocha-Gon ... S. Martins 1, RM Soares 1 , F. Miranda% MU Ferreira 1, A. Fiarresga 1 , J. Feliciano 1 , N. Pelicano 1 , CB Palma 2, B. Oliveira 2, J. Qnininha t ...
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1992
The present work is an attempt to provide a general overview on the current methods and applicati... more The present work is an attempt to provide a general overview on the current methods and applications of heart rate variability (HRV), starting from the underlying mechanisms of cardiac rhythmic automaticity and the influence on heart rate of biological modulators, namely autonomous nervous system. Different evaluation methods for HRV are compared in what concerns the duration of the records under analysis and the mathematical approach (spectral/non-spectral). Finally, clinical applications of HRV are mentioned, some of them the Department is particularly interested in, namely coronary heart disease, heart failure and diabetic neuropathy. The authors conclude, minding some aspects susceptible of discussion in the future of this technique.
Revista portuguesa de cardiologia : orgão oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology, 1993
1--To determine the accuracy of the echocardiographic selection and characterization of the pulmo... more 1--To determine the accuracy of the echocardiographic selection and characterization of the pulmonary stenosis (PS) for balloon valvuloplasty; 2--To analyze the differences between children and adults in obtaining the echocardiographic parameters used for pulmonary stenosis characterization. We studied 53 consecutive patients with PS and a peak Doppler gradient > or = 40 mmHg, submitted to cardiac catheterization to perform balloon valvuloplasty if the right ventricle to pulmonary artery peak-to-peak systolic pressure gradient was > or = 40 mmHg. The patients were divided into 3 groups on the basis of age: < or = 5 years (group 1; n = 18), 6-16 years (group 2; n = 17) and > 16 years (group 3; n = 18). A complete echocardiographic study was performed including identification of valvular morphology (commissural fusion, dysplasia or mixed), determination of right ventricle to pulmonary artery peak Doppler gradient and the transducer position that yielded the highest transva...
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